Prior Authorization Workflow Consultant

Responsibilities

• Own the operational workstream deliverables for customer implementations including discovery, data collection and analysis of Prior Authorization workflows.
• Proactively manage all operational workstream tasks of the implementation project plan.
• Be a collaborative and communicative member of the implementation project team, ensuring implementation project manager has visibility into operational progress and risks.
• Conduct operational workflow and portal shadowing sessions with customers, asking thoughtful and specific questions to understand their current processes. Identify risks related to the successful implementation of Humata’s PA technology.
• Capture and document operational workflows in Humata’s design workbook to inform solution build and develop prior authorization workflows.
• Review customer payer/plan mix and formulate automation workflow recommendations.
• Audit and adapt future-state workflows and payer/portal additions for customers during stabilization and maintenance phases post go-live.
• Create payer portal credentials to support Humata’s automations.
• Own payer portal validation during testing and go-live project phases; collaborate with the customer’s operations/technical teams to review automation results.
• Document and escalate validation issues to be reviewed/resolved by Humata’s Engineering team.

Requirements

• Bachelor’s degree in Business, Healthcare Administration, or a related field.
• 3+ years hands’ on Prior Authorization experience.
• Familiarity with healthcare operations, prior authorization, or revenue cycle workflow optimization.
• Systems knowledge/expertise with Epic (referrals, work queues, coverage), payer portals, and revenue cycle operations.
• Hands-on data analysis experience, ability to analyze referral volumes service line/payer. This role requires a strong analytical mindset and ability to synthesize large data volumes and make informed decisions based on data analysis.
• Organized, able to document processes (both current state and future-state automations) succinctly.
• Comfortable with ambiguity, shifting priorities and building new processes in an evolving start-up environment.
• Collaborative team player with a consultative approach to client engagement and solution development.
• Utilize PowerBI for reporting, Google Workspace, Slack.
• Willingness to travel as required (up to 25%) for customer onsite discovery sessions and all-company meetings.